Cutaneous SCC, adjuvant

Question 1

Indications

Answer 1

“Indications for RT
positive margin that cannot be re-excised, PNI, immunosupression, parotid location, multiple recurrences, near important structures.

Neck: node positive, ECE

consider RT vs. observation
close margin, T3, T4. Consider RT for some facial sites, or not. (ASTRO guidelines recommend RT, NCCN allows observation. Low evidence)”

Question 2

Fields

Answer 2

“As in post op head and neck

CTV: +5 mm margin around high risk areas, or up to 10 mm in areas of uncertainty (HNCIG guidelines)

Optional inclusion of in-transit lymphatics in node positive

If nodes are negative: observation of nodal areas is an option

If parotid node positive: include levels Ib-III as low risk. Consider IV & V.

If positive nodes in levels I-III: include levels IV-V as low risk

If positive nodes in leves IV-V: include levels Vb-Vc as low risk

Trace PNI, especially if extensive or clinical. Some do not trace PNI for minimal invasion

HNCIG guidelines, Porceddu et al, IJROBP, 2020”